Changes to your dose or treatment delays

Sometimes a treatment may be started at a lower dose or the dose needs to be changed during treatment. There may also be times when your treatment is delayed. This can happen if your doctor thinks you are likely to have severe side effects, if you get severe side effects, if your blood counts are affected and causing delays in treatment, or if you are finding it hard to cope with the treatment. This is called a dose reduction, dose change or treatment delay. Your doctor will explain if you need any changes or delays to your treatment and the reason why.

Blood tests and monitoring

Anticancer drugs can reduce the number of blood cells in your body. You will need to have regular blood tests to check that your blood cell count has returned to normal. If your blood count is low your treatment may be delayed until it has returned to normal. Your doctor or nurse will tell you when to have these blood tests.

Other medications given during this treatment

Anti-sickness (anti-nausea) medication: you may be given some anti-sickness medication.Make sure you take this medication as your doctor or nurse tells you, even if you don’t feel sick. This can help to prevent the sickness starting.

Docetaxel premedication: before your treatment with docetaxel you may need to take a tablet called a premedication to help prevent you from having a reaction to docetaxel. A steroid tablet called dexamethasone may be used and should be taken with or after food as directed. The following table may be used to remind you when to take your premedication. Ask your doctor, nurse or pharmacist to fill it out for you.

Tablet

Dose

When to take

Tell your doctor or nurse if you have not taken your premedications before you have your treatment.

This treatment lowers the amount of white blood cells in your body. The type of white blood cells that help to fight infection are called neutrophils. Having low level of neutrophils is called neutropenia. If you have neutropenia, you are at greater risk of getting an infection. It also means that your body can’t fight infections as well as usual. This is a serious side effect, and can be life threatening.

Wash your hands often.

Keep a thermometer at home and take your temperature regularly, and if you feel unwell.

Do your mouth care regularly.

Inspect your central line site (if you have one) daily for any redness, pus or swelling.

Tell your doctor or nurse immediately, or go to your nearest hospital Emergency Department if your diarrhoea is not controlled, you have 4 or more loose bowel motions per day, and if you feel dizzy or light-headed.

Tiredness and lack of energy (fatigue)

You may feel very tired, have no energy, sleep a lot, and not be able to do normal activities or things you enjoy.

Do not drive or operate machinery if you are feeling tired.

Nap for short periods (only 1 hour at a time)

Prioritise your tasks to ensure the best use of your energy.

Eat a well balanced diet and drink plenty of fluids (unless you are fluid restricted).

Try some gentle exercise daily.

Allow your friends and family to help.

Tell your doctor or nurse if you get any of the symptoms listed above.

Joint and muscle pain and stiffness

You may get muscle, joint or general body pain and stiffness.

Applying a heat pack to affected areas may help.

Talk to your doctor or nurse about other ways to manage these symptoms. You may need medication to help with any pain.

Chemotherapy safety

Blood clot risk

Cancer and anticancer drugs can increase the risk of a blood clot (thrombosis).

Tell your doctor if you have a family history of blood clots.

A blood clot can cause pain, redness, swelling in your arms or legs, shortness of breath or chest pain.

If you have any of these symptoms go to your nearest hospital Emergency Department.

Medications and vaccinations

Before you start treatment, tell your doctor about any medications you are taking, including vitamins or herbal supplements.

Don’t stop or start any medications during treatment without talking to your doctor and pharmacist first.

Paracetamol is safe to take if you have a headache or other mild aches and pains. It is recommended that you avoid taking aspirin, ibuprofen and other anti-inflammatory type medications for pain while you are having treatment. However, if these medications have been prescribed by your doctor, do not stop taking them without speaking with your doctor.

Vaccinations such as flu and tetanus vaccines are safe to receive while having treatment. Do not have any live vaccines during your treatment or for 6 months after it finishes. If you are unsure, check with your doctor before you have any vaccinations.

People you live with should be fully vaccinated, including having live vaccines according to the current vaccination schedule. Extra care needs to be taken with hand washing and careful disposal of soiled nappies for infants who have recently received the rotavirus vaccine.

Other medical and dental treatment

If you go to hospital or any other medical appointment (including dental appointments), always tell the person treating you that you are receiving anticancer drugs.

Before you have any dental treatment, talk to your doctor.

Diet

While you are receiving this treatment it is important that you try to maintain a healthy diet.

Grapefruit and grapefruit juice can interact with your medication and should be avoided while you are on this treatment.

Speak to your doctor or nurse about whether drinking alcohol is safe with your treatment.

If you have any concerns about recent weight loss or weight gain or questions about your diet, ask to speak to a dietitian.

Fertility

Some cancer treatments can reduce your fertility. This can make it difficult or impossible to get pregnant or father a child.

Talk to your doctor or nurse before you start any treatment. Depending on your situation there may be fertility sparing options available to you and/or your partner, discuss these with your doctor or nurse.

Pregnancy and breastfeeding

Some cancer treatments can be dangerous to unborn babies. Talk to your doctor or nurse if you think there is any chance that you could be pregnant.

Do not try to get pregnant or father a child during this treatment. Ask your doctor or nurse about what type of contraception you should use.

Do not breastfeed if you are on this treatment as anticancer drugs can also pass into breast milk.

Sex life and sexuality

The desire to have sex may decrease as a result of this treatment or its side effects.

Your emotions and the way you feel about yourself may also be affected by this treatment.

It may help to discuss your concerns with your partner and doctor or nurse.

For more information about cancer treatment, side effects and side effect management see our Patient and carers section.

Quit smoking information and support

Quitting smoking is helpful even after you have been diagnosed with cancer. The following resources provide useful information and support to help you quit smoking. Talk to your doctor, nurse or pharmacist about any other questions you may have.

This document is a guide only and cannot cover every possible situation. The health professionals caring for you should always consider your individual situation when making decisions about your care. Contact your cancer clinic staff or doctor if you have any questions or concerns about your treatment, or you are having problems coping with side effects. Use of this document is subject to eviQ’s disclaimer available at www.eviQ.org.au

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